Residing in deprived areas may increase risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. The aim of this study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer- and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors.

Methods

In the longitudinal NIH-AARP Study, we analyzed data from healthy participants, ages 50–71 years at study baseline (1995–1996). Deaths (n = 33831) were identified through December 2005. Information on census tracts was obtained from the 2000 US Census. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of neighborhood deprivation.

Higher neighborhood deprivation was associated with modest increases in all-cause, cancer- and CVD-mortality after accounting for many established risk factors.

This is a particularly interesting study because of its efforts to control for "person-specific risk factors" in the hopes of evaluating the extent to which simply living in a deprived neighborhood can produce deleterious effects on health. The fact that the investigators found statistically significant increases between such deprivation and all-cause, cancer, and CVD mortality is both unsurprising and significant given the increasing evidence in the SDOH literature that "place matters." Here the authors posit some mechanisms for the relationship:

"Potential mechanisms by which neighborhood deprivation may influence mortality include physical environment/environmental exposures and social norms. In particular, areas with higher deprivation may have issues such as limited availability of or access to healthy foods and health care, higher environmental pollution, and lack of social networks that might also impact mortality risk independently of the characteristics of the people living in those areas."

November 29, 2010

In February of 2007, Harvard Medical School's Center for the History of Medicine started the Foundations in Public Health Policy program in an attempt to process and make available a number of "hidden collections" related to public health. These collections are now open to research.

The Allan Macy Butler Papers: Butler, an academic, pediatrician, researcher, and political activist, was Chief of the Children's Medical Service at Massachusetts General Hospital, Boston and Professor of Pediatrics at Harvard Medical School from 1942 to 1960.

The Leona Baumgartner Papers: Baumgartner was the first woman commissioner of the New York City Department of Health, 1954 to 1962, and was later a national advocate and adviser to the federal government on the expansion of public health efforts in maternal health, preventive medicine, and international aid

The Howard Hiatt Papers: Hiatt was the first Herrman L. Blumgart Professor of Medicine at Harvard Medical School and Physician-in-Chief at Beth Israel Hospital in Boston, Mass from 1963 to 1972. Staff also processed a separate archival collection of Dean's Records from Hiatt's time as leader of the Harvard School of Public Health from 1972 to 1984.

The David D. Rutstein Papers: Rustein headed the Harvard Medical School Department of Preventive Medicine from 1947 to 1971 and hosted a television program on WGBH, The Facts of Medicine, one of the first uses of television to inform the public about local and national health concerns and current research.

Also available are the papers of epidemiologist Alexander Langmuir (1953-1972), the class notes of Harvard School of Public Health student Irma S. Jarcho (1944-1945), the papers of James L. Whittenberger (1933-1963), who studied the physiology of respiration and effects of air contamination on respiratory diseases, and the papers of Richard Pearson Strong (1911-2004), who the first Professor of Tropical Medicine at Harvard, and between 1913 and 1934 made several expeditions to afflicted areas in South and Central America and Africa to investigate diseases and obtain material for his laboratory and teaching work.

Since the Foundations of Public Health Policy initiative began, the project team has made incredible progress in processing manuscript collections, and we will continue to test our collection discovery tools, engage in outreach activities and communication with the public health and archives communities, and work with public health researchers and scholars in cultivating the acquisition of related collections. For more information on these collections, and links to online finding aids and digitized content, or to participate in a survey about our collection discovery tools, visit www.countway.harvard.edu/fphp, or contact Michael Dello Iacono, Project Archivist, at mpd13@hms.harvard.edu.

November 22, 2010

Disease stigma is an increasingly central topic both on MH Blog and in my own work. It is especially relevant to thinking about public health ethics and public health policy, because the history of public health in the West both in premodern and modern eras reveal a considerable profligacy of such stigma, usually directed at disenfranchised and marginalized groups. As numerous historians of public health have argued (see especially Simon Szreter's wonderful History & Policy project and, of course, his extensive scholarship), part of the significance of studying such history is understanding how relevant it is to our daily practices. Although one dare not make the mistake of thinking that the value of studying history is purely for instrumental reasons, the history of stigma and public health is nevertheless highly significant for understanding current matters in public health policy.

Historians, ethicists, and social scientists studying HIV/AIDS have emphasized this framework in particular because of the abundant evidence of such stigmatization that attended and still attends the disease. Although the literature on this subject is abundant, I post here to note a new article published by Charlene Galarneau in the current issue of Public Health Ethics entitled "‘The H in HIV Stands for Human, Not Haitian': Cultural Imperialism in US Blood Donor Policy." Here is the Abstract:

Ethical reflection on the justice/injustice of past public health policy can inform current and future policy creation and assessment. For eight years in the 1980s, Haitians were prohibited from donating blood in the USA due to their national origin, a supposed risk factor for AIDS. This case study underlines the racial stereotypes and cultural ignorance at play in risk assignment—which simultaneously marked Haitians as risky ‘others’ and excluded them as significant participants in policy-making. This article also discerns Haitian understandings of justice related to this donor policy and explores how dimensions of this past policy relate to current blood donor policy.

The Pennsylvania Hospital, Philadelphia, will host its sixth annual History of Women's Health Conference on Thursday, April 28, 2011. We invite interested persons to send a one to two page proposal or abstract of your topic by Friday, December 10, 2010 for consideration. The History of Women's Health Conference focuses on women's health issues from the late 18th century to the present. This conference encourages interdisciplinary work. The theme of this year's conference will be "Nursing's Contribution to Women's Health." Defined broadly, we will welcome submissions regarding any aspect of nursing from the 18th c to the modern era, including midwifery, nursemaids, wet nurses, nursing schools, changes in nursing programs, the professionalization of nursing, role of the care giver during any era, the role of "mother" in the care of the family and society, etc.

We are very happy to announce that our keynote speaker this year will be internationally renowned nurse historian Julie Fairman, PhD, RN, FAAN.Dr. Fairman is currently the Director of the Barbara Bates Center for the Study of the History of Nursing. She is the author of two critically acclaimed books, Critical Care Nursing: A History (University of Penn Press, 1998), authored with her mentor, Dr. Joan Lynaugh, and Making Room in the Clinic: Nurse Practitioners and the Evolution of Modern Health Care (Rutgers University Press, 2008), an analysis of the American nurse practitioner movement.

Pennsylvania Hospital, the nation's first hospital, is a 515-bed acute care facility that provides a full range of diagnostic and therapeutic medical services and functions as a major teaching and clinical research institution. For more information please visit our web site at http://pennhealth.com/pahosp/

Papers will be considered for inclusion in the theme issue as well as in subsequent issues of the journal.

The theme issue of Health Affairs will explore the current state of knowledge about how factors in the natural and built environments – including polluted air or water, chemicals, and climate change -- affect human health.

We seek to begin to bridge the gap in understanding between those who have long focused on these environmental contributors to health, and those who have traditionally focused on such areas as health services delivery and financing. The ways in which environmental stressors adversely impact the most vulnerable members of society will also be an important focus of the thematic issue.

We seek to present the latest research on environmental health threats and policies that have worked to minimize or ameliorate them. In particular, we hope to cast a spotlight on regulatory agencies and the regulatory frameworks that guide their actions. We also plan to present case studies of selected health impacts attributable to environmental conditions or aggravated by them. Research papers as well as analyses and commentaries from various viewpoints will be considered for publication.

This issue of Health Affairs is supported by a grant from the Kresge Foundation.

Timetable

The journal welcomes original papers, analyses, and commentaries for the thematic issue by December 15, 2010.

Health Affairs editors and the theme issue advisors (Drs. J. Pete Myers, Kenneth Olden, and Tracey Woodruff) will evaluate submissions and make initial selection of those which warrant further consideration. Health Affairs will publish additional papers on environmental health through 2011.

Papers submitted after December 15, 2010 will be considered for publication in future issues of the journal.

Considering the short timeline, we do not expect all authors to initiate new research, but encourage synthesizing existing work to frame the issues and inform policy discussions and deliberations for an audience that heretofore may not have devoted much thought to environmental health.

Selected papers will be subjected to peer-review by external reviewers in a double blind process which masks the identity of both authors and reviewers. Authors of papers that are determined to be appropriate will be asked to revise their papers in January and February.

Copyediting and production for the issue will take place following that, with publication scheduled for early May 2011.

We invite submissions of original quantitative and qualitative research that explore the scientific, societal, and economic aspects of environmental health policy, addressing the following questions and topic areas:

Why should health policymakers care about environmental health?

What are the key drivers/players in environmental health?

How does environmental health impact long term health care costs?

What is the current knowledge base about environment health and policy?

Where are the policy opportunities and obstacles to reduce negative environmental impacts on health?

November 16, 2010

I do not often discuss the (dis)appearance of other blogs in the main text, mainly for time and energy reasons, but I did want to depart from convention and highlight the appearance of a new group blog entitled Inequalities: Research and Reflection from Both Sides of the Atlantic. The blog has an Anglophone focus, and features a number of promising posts from a number of students and scholars.

November 15, 2010

Since its beginnings in September 2006 -- we're at four years now! -- I have tried on MH Blog to emphasize the importance of historicizing the humanities, of understanding the themes and issues most relevant to the key shapers of the educational program known as the studia humanitatis.

Although the Western humanities are of course ancient in origin, they were mediated in crucial ways by medieval and Renaissance humanists whom, I have argued, were primarily interested in practical engagement with the world. Their program took off at least in part from dissatisfaction with the cloistered nature of Scholastic pedagogy, and many of the humanists sought to apply erudition in the service of virtu in one's daily practices and lives. In my entirely subjective and relatively uninformed view, the paragon of this ideal, and hence the patron saint of MH Blog, is Montaigne.

Part of my rationale for discussing these sources is my sense -- a sense which I admit I have failed to find a language adequate to persuade -- that this historicization has relevance for contemporary humanities scholars, including those working on issues of health, illness, and human suffering. Therefore, from time to time on MH Blog, I have mused on the significance of the humanities both in higher education and in the polis itself.

That the humanities are deemphasized within American higher education is at this point beyond dispute as far as I am concerned. Hence the recent decision of SUNY Albany to terminate its French, Italian, Russian, Classics, and Theater Arts programs was sad but unsurprising (which is not to imply it is acceptable). In response to this news, a professor of biochemistry at Brandeis University, composed this remarkable open letter to the President of SUNY Albany, which was published, in all places, in the BMC journal Genome Biology. Like all articles published in a BMC journal, it is available full-text open-access. The letter is absolutely worth reading in its entirety, but below the jump I have provided a few excerpts to whet your appetite:

November 04, 2010

Special Issue of the Journal of Medical Humanities: "Queer in the Clinic"

Guest Editors: Lance Wahlert and Autumn Fiester

We invite the submission of abstracts for a special issue of the Journal of Medical Humanities, which will consider queer perspectives on and queer experiences in the clinic. While all professionals and patients face dilemmas within the medical sphere, for LGBTQ individuals the stakes are especially pronounced and complicated. According to critical theorists like Michel Foucault and others, the clinic is an intensely problematic space for queers because many of their identities and categories were born there. While debatable, such a historical and scholastic legacy hangs heavy over our readings and renderings of gay and trans persons in the medical realm. Stated succinctly: Historically having been born out of medical pathology,how do queer persons understand and even reconcile their relationships to the clinic today?

This special issue of the Journal of Medical Humanities will be concerned with the voices and perspectives of LGBTQ persons in the medical sphere – the dilemmas they face in the clinic, the influences that sexuality and gender identity have on a person’s patient-hood, and the factors that create distinctively queer perspectives on medicine. Some over-arching questions that inform this special issue include:

 What does the experience of being lesbian, gay, bisexual, transgender, or intersex in a medical encounter look like – as either patient or health-care provider?

 How do queer sexualities and gender identities factor into clinical relationships, the experience of being ill, and the negotiations for treatment and care?

today there are groups that carry a severe and disproportionate burden of our focus diseases. To address this imbalance, we must complement individual- level interventions, intended to influence knowledge, attitudes, and behaviors, with new approaches that address the interpersonal, network, community, and societal influences of disease transmission and health. Evidence suggests that programs that comprehensively address health where we live, work, learn, and play can have greater impact on health outcomes at the population level than programs utilizing interventions aimed solely at individual behavior change.*

This last point is particularly important, since it reflects some of the underpinnings of the prevention paradox I have mentioned here on MH Blog, as well as a developing literature suggesting that individualistic, so-called "agentic" interventions depend to a large extent for their success on the resources available to individuals (e.g., Capewell and Graham 2010). Not only are such interventions therefore less likely to be successful among those socially, economically, and politically disadvantaged populations that bear disproportionate burdens of disease, but as a result may also expand inequities.

Thus the argument for a whole population approach, one that addresses the structural determinants of health and illness across and within populations.

Major considerations of disability studies—such as provision of care, accommodation for disabled people, and issues surrounding institutionalization—have been consistently marginalized in American bioethical discourse. The right to die, however, stands out as a paradigmatic bioethical debate. Why do advocates for expanding the volition and self-direction of disabled people emerge from the periphery only to help those disabled people who choose death? And why do the majority of people assume an unrealistically low quality of life for those with disabilities? This paper will argue that the dominance of the Western liberal tradition in American culture motivates both these phenomena: by emphasizing individual rights over duties and responsibilities, assuming the isolated and independent rights-bearer as the prototypical person, and evoking an unrealistically atomistic view of human interaction. As an alternative, I offer a framework rooted in feminist ethics that emphasizes context, gives moral weight to human relationships, abandons the problematic ideal of a lone rights-bearer, and emphasizes the mutual vulnerability of embodied individuals.

I am so pleased to see such challenges to dominant individualist conventions in American bioethics, and both feminist and disability lenses provide particularly helpful vantage points for unpacking the weaknesses of what Charles Taylor refers to as "methodological individualism." If Wardlaw's topic interests readers, also check out Paul Longmore's powerful article, cited here, entitled Policy, Prejudice, and Reality: Two Case Studies of Physician-Assisted Suicide. I've taught this article on several occasions, and the students have almost uniformly reported it to be -- forgive the cliche -- paradigm-shifting.

Check out Wardlaw's article, and the entire issue.

(*Disclosure: Margaret Wardlaw is a friend and a colleague, as well as a graduate student with me during my training at IMH).

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